Bioelectrical impedance spectroscopy for the assessment of body fluid volumes of term neonates

Determinants of body composition in breastfed infants using bioimpedance spectroscopy and ultrasound skinfolds-methods comparison

BACKGROUND

Accurate, noninvasive, and inexpensive methods are required to measure infant body composition. Ultrasound (US) and bioimpedance spectroscopy (BIS) have been validated in adults and introduced in pediatric populations. The aim of this study was to evaluate the performance of both methods in determining percentage fat mass (%FM) in breastfed infants.

METHODS

%FM of 2, 5, 9, and 12 mo-old healthy, breastfed term infants (n = 58) was calculated using BIS-derived total body water equations and skinfold equations then compared with reference models. Skinfolds were measured with US at two and four sites (biceps, suprailiac and/or triceps, and subscapular).

RESULTS

%FM differed widely within and between methods, with the degree of variation affected by infant age/sex. Not a single method/equation was consistent with the distributions of appropriate reference values for all age/sex groups. Moderate number of matches with references values (13-24 out of 36) was seen for both types of equations. High number of matches (25-36) was seen for US skinfold-based equations. %FM values calculated from US and BIS were not significantly different (P = 0.35).

CONCLUSION

Both BIS and US are practical for predicting %FM in infants. BIS calculations are highly dependent upon an appropriate set of validated age-matched equations.

Bioimpedance spectroscopy in the infant: effect of milk intake and extracellular fluid reservoirs on resistance measurements in term breastfed infants

BACKGROUND/OBJECTIVES

Bioimpedance spectroscopy is an accurate non-invasive method for measuring body composition in adults, but in infants it requires further testing and validation. Of the few studies of bioimpedance conducted in infants, none have comprehensively investigated the effect of milk intake volume. This study assessed the effect of the milk intake, feed duration and the volume of the infant's stomach and bladder on the resistance values pre-/post-feed to establish the feasibility of using these values interchangeably during data collection.

SUBJECTS/METHODS

Forty-eight breastfeeding infants were measured at 2, 5, 9 and/or 12 months (n=62 sessions) within 1-2 min before the start and after the end of breastfeed. Median (IQR) time between measurements was 24 (20.0-30.0) min. Resistance measurements at 0 and 50 kHz, and infinite frequency (R0, R50 and Rinf) and resistance of intracellular water (Ricw) were analysed with customised infant settings. Milk intake was measured by test weights. Free-water volumes and free-water change were determined from stomach and bladder volumes calculated from ultrasound images.

RESULTS

Small pre-to-post-feed changes (median (IQR): R0 -3.7 (-14.8, 14.3); R50 0.3 (-10.4, 15.0); Rinf 2.8 (-13.3, 35.5); Ricw 20.8 (-98.1, 290.9)) were not significantly different from zero (R0: P=0.92; R50: P=0.48; Rinf: P=0.32; Ricw: P=0.097). No significant effect of milk intake or free-water change was detected.

CONCLUSIONS

The lack of consistent change in resistance across a breastfeed provides flexibility in the timing of measurements of infants in the research setting, such that typically pre- and post-feed measures of resistance can be used interchangeably.

Multi-frequency simultaneous measurement of bioimpedance spectroscopy based on a low crest factor multisine excitation

Bioimpedance spectroscopy (BIS) is becoming a powerful diagnostic tool for a wide variety of medical applications, and the multi-frequency simultaneous (MFS) measurement of BIS can greatly reduce measurement time and record the transient physiological status of a living body compared with traditional frequency-sweep measurement technology. This paper adopts the Van der Ouderaa's multisine, which has 31 equidistant and flat amplitude spectra and a low crest factor of 1.405 as the broadband excitation, and realizes the MFS measurement of BIS by means of spectral analysis using the fast Fourier transform algorithm. The approach to implement the multisine based on a field-programmable gate array and a digital to analog converter is described in detail, and impedance measurement experiments are performed on three resistance-capitance three-element phantoms. Experimental results show a commendable accuracy with a mean relative error of 0.55% for the impedance amplitudes, and a mean absolute error of 0.20° for the impedance phases on the 31 frequencies ranging linearly from 32 to 992 kHz. This paper validates the feasibility of the MFS technology for BIS measurement based on the multisine excitation.

Assessing early growth and adiposity: report from an EarlyNutrition Academy workshop

This report provides a summary of a workshop organised by the European Commission-funded EarlyNutrition Project and the EarlyNutrition Academy. Accurate and reliable methods to assess body composition are needed in research on prenatal and early post-natal influences of nutrition on later health because common surrogate measures of maternal and offspring adiposity (body fat content), such as body mass index (BMI), have relatively poor predictive power for the risk of later disease. The key goals of the workshop were to discuss approaches to assess growth and body composition from pregnancy to adolescence, to summarise conclusions and to prepare a framework for research in the EarlyNutrition Project. The participants concluded that there is a pressing need to harmonise the methodologies for assessing body composition, recognising that each has advantages and limitations. Essential core measurements across studies assessing early growth and body composition were identified, including weight, length, BMI, waist and mid-upper arm circumference, subscapular and triceps skinfold thicknesses, and bioelectrical impedance analysis. In research settings with access to more sophisticated technologies, additional methods could include dual-energy X-ray absorptiometry, peripheral quantitative computed tomography, ultrasound assessment of regional body fat, magnetic resonance imaging (MRI), air displacement plethysmography (ADP), and deuterium dilution. These provide richer data to answer research questions in greater depth but also increase costs. Where overall whole-body composition is the primary outcome measure, ADP or tracer dilution should be used whenever possible. Where regional distribution of body fat is of greater interest, an imaging technique such as MRI is preferred.

Bioelectrical impedance analysis for assessment of fluid status and body composition in neonates--the good, the bad and the unknown

BACKGROUND/OBJECTIVES

There is a critical need for improved technologies to monitor fluid balance and body composition in neonates, particularly those receiving intensive care. Bioelectrical impedance analysis meets many of the criteria required in this environment and appears to be effective for monitoring physiological trends.

SUBJECT/METHODS

The literature regarding the use of bioelectrical impedance in neonates was reviewed.

RESULTS

It was found that prediction equations for total body water, extracellular water and fat-free mass have been developed, but many require further testing and validation in larger cohorts. Alternative approaches based on Hanai mixture theory or vector analysis are in the early stages of investigation in neonates.

CONCLUSIONS

Further research is required into electrode positioning, bioimpedance spectroscopy and Cole analysis in order to realise the full potential of this technology.

Prediction of fat-free mass and percentage of body fat in neonates using bioelectrical impedance analysis and anthropometric measures: validation against the PEA POD

Accurate assessment of neonatal body composition is essential to studies investigating neonatal nutrition or developmental origins of obesity. Bioelectrical impedance analysis or bioimpedance analysis is inexpensive, non-invasive and portable, and is widely used in adults for the assessment of body composition. There are currently no prediction algorithms using bioimpedance analysis in neonates that have been directly validated against measurements of fat-free mass (FFM). The aim of the study was to evaluate the use of bioimpedance analysis for the estimation of FFM and percentage of body fat over the first 4 months of life in healthy infants born at term, and to compare these with estimations based on anthropometric measurements (weight and length) and with skinfolds. The present study was an observational study in seventy-seven infants. Body fat content of infants was assessed at birth, 6 weeks, 3 and 4·5 months of age by air displacement plethysmography, using the PEA POD body composition system. Bioimpedance analysis was performed at the same time and the data were used to develop and test prediction equations for FFM. The combination of weight+sex+length predicted FFM, with a bias of < 100 g and limits of agreement of 6–13 %. Before 3 months of age, bioimpedance analysis did not improve the prediction of FFM or body fat. At 3 and 4·5 months, the inclusion of impedance in prediction algorithms resulted in small improvements in prediction of FFM, reducing the bias to < 50 g and limits of agreement to < 9 %. Skinfold measurements performed poorly at all ages.

Reference distribution of the bioelectrical impedance vector in healthy term newborns

Bioelectrical impedance vector analysis (BIVA) is a new method that is used for the routine monitoring of the variation in body fluids and nutritional status with assumptions regarding body composition values. The aim of the present study was to determine bivariate tolerance intervals of the whole-body impedance vector and to describe phase angle (PA) values for healthy term newborns aged 7-28 d. This descriptive cross-sectional study was conducted on healthy term neonates born at a low-risk public maternity. General and anthropometric neonatal data and bioelectrical impedance data (800 μA-50 kHz) were obtained. Bivariate vector analysis was conducted with the resistance-reactance (RXc) graph method. The BIVA software was used to construct the graphs. The study was conducted on 109 neonates (52.3% females) who were born at term, adequate for gestational age, exclusively breast-fed and aged 13 (SD 3.6) d. We constructed one standard, reference, RXc-score graph and RXc-tolerance ellipses (50, 75 and 95%) that can be used with any analyser. Mean PA was 3.14 (SD 0.43)° (3.12 (SD 0.39)° for males and 3.17 (SD 0.48)° for females). Considering the overlapping of ellipses of males and females with the general distribution, a graph for newborns aged 7-28 d with the same reference tolerance ellipse was defined for boys and girls. The results differ from those reported in the literature probably, in part, due to the ethnic differences in body composition. BIVA and PA permit an assessment without the need to know body weight and the prediction error of conventional impedance formulas.

Comparison of two bioimpedance spectroscopy techniques in the assessment of body fluid volumes

The present study aimed to compare the estimates of body liquid volumes performed by two bioimpedance spectrometry techniques. One based on a step response technique (BIS-PEB) and second one based on multifrequency Xitron Hydra 4200 equipment (Xitron Technologies, San Diego, CA, USA). The convenience sample was initially composed of 422 students from a military parachuting course of the Brazilian Army. From such sample 42 male students were randomly selected to be evaluated during three weeks. The anthropometrical characteristics of the sample can be summarized as: 25.18 +/- 4.10 years old; weight equals of 76.77 +/- 7.84 kg; height equals to 174.96 +/- 5.67 cm; body mass index (BMI) equal to 25.05 +/- 2.11 kg m(-2). Bland-Altman graphics were used to compare the two methods in what concerns to estimate of extracellular fluid (ECF), intracellular fluid (ICF), and total body water (TBW). One can observe that the estimates of the two techniques present a good correlation, especially in the case of ECF (r = 0.975). The present study indicates that BIS-PEB technique associated with De Lorenzo equation can supply noninvasive estimates of body fluid volumes comparable to Xitron Hydra 4200 equipment.

Objective assessment of knee osteroarthritis in parachuters by bioimpedance spectroscopy

The aim of the present study was to derive an objective and noninvasive assessment of osteoarthritis of the knee joint by bioimpedance spectrocopy (BIS). The study was performed in Brazilian Military Parachuters and intends to contribute to the improvement of the early diagnosis of joint degeneration. Twelve male volunteers (24 knee joints) participated in the study. A novel index (ID) to assess the disease was proposed from the raw bioimpedance parameter. This index was compared with a subjective rating (Dejour scale) performed by 3 therapists. The results indicated that the values of ID were significantly different (p0.001) between the control group (class 1 of Dejour) and the pathological group (class 2 or higher). A Spearman correlation of -0.81 between the values of ID and the therapists rating was detected. Despite the need of increasing the sample size, the novel technique seems to be capable of supplying an objective and non-invasive tool for helping the diagnosis of the knee osteoarthritis.